血乳酸及ROX指数在经鼻湿化高流量氧疗治疗高龄慢性阻塞性肺疾病急性加重期中的应用价值  

Application Value of Blood Lactate and ROX Index in Humidification High-flow Nasal Cannula Oxygen Therapy for Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：杨玉梅 梁锡铭[1] 孙志峰[1] 来纯云[1] 赵静[1] Yang Yumei;Liang Ximing;Sun Zhifeng;Lai Chunyun;Zhao Jing(Department of Respiratory and Critical Care Medicine,the Second Medical Center of the General Hospital of the People's Liberation Army,National Clinical Medical Research Center for Geriatric Diseases,Beijing 100853)

机构地区：[1]解放军总医院第二医学中心呼吸与危重症医学科国家老年疾病临床医学研究中心,北京100853

出　　处：《国际老年医学杂志》2024年第1期11-17,共7页International Journal of Geriatrics

基　　金：国家重点研发计划课题项目(2020YFC2009003)。

摘　　要：目的探究血乳酸(Lac)及ROX指数在经鼻湿化高流量氧疗(HFNC)治疗高龄慢性阻塞性肺疾病急性加重期(AECOPD)患者中的应用价值。方法选取2020年3月—2023年3月在解放军总医院第二医学中心呼吸与危重症医学科就诊的82例接受HFNC治疗的AECOPD患者作为研究对象,根据HFNC持续治疗48 h的结果将患者分为有效组(53例)和无效组(29例)。比较两组临床资料及血Lac和ROX指数,并通过logistic回归模型分析影响HFNC治疗无效的相关因素;用ROC曲线分析血Lac与ROX指数对HFNC治疗无效的预测价值。结果无效组年龄、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、C-反应蛋白(CRP)、治疗前和治疗12 h后血Lac均高于有效组(P<0.05),白蛋白(ALb)水平、治疗前和治疗12 h后氧合指数及ROX指数低于有效组(P<0.05)。多因素logistic回归分析显示,APACHEⅡ评分偏高、治疗前和治疗12 h后血Lac偏高是影响HFNC治疗无效的危险因素(P<0.05),治疗前和治疗12 h后ROX指数偏高是其保护因素(P<0.05)。ROC曲线显示,治疗前和治疗12 h后血Lac、治疗前和治疗12 h后ROX指数预测HFNC治疗无效的AUC(95%CI)分别为0.680(0.568~0.779)、0.730(0.621~0.822)、0.776(0.670~0.860)、0.823(0.723~0.899)。结论高龄AECOPD患者HFNC治疗前和治疗12 h后血Lac水平偏高与ROX指数偏低是影响HFNC持续治疗48 h无效的危险因素,且治疗前及治疗12 h后血Lac与ROX指数均可作为评估HFNC治疗效果的可靠参考指标。Objective To investigate the application value of blood lactic acid(Lac)and ROX index in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)by nasal humidification high-flow oxygen therapy(HFNC).Methods A total of 82 patients with AECOPD who visited the Department of Respiratory and Critical Care Medicine of the Second Medical Center of the PLA General Hospital from March 2020 to March 2023 were selected as the study subjects and treated with HFNC.Patients were divided into effective(n=53)and ineffective(n=29)groups according to the continuous treatment of HFNC for 48 h.The clinical data and serum Lac and ROX indices were compared between the two groups,and the related factors affecting the ineffective treatment of HFNC were analyzed by a mlogistic regression model,the predictive value of blood Lac and ROX indices for the ineffective treatment of HFNC was analyzed by ROC curve.Results The age,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,C-reactive protein(CRP),blood Lac before and 12 h after treatment in the ineffective group were all higher than those in the effective group(P<0.05),and albumin(ALb)levels,oxygenation index,and ROX index before and 12 h after treatment were lower than those in the effective group(P<0.05).Multivariate logistic regression analysis showed that high APACHEⅡscore and high blood Lac before and 12 h after treatment were risk factors affecting the ineffective treatment of HFNC(P<0.05),and high ROX index before and 12 h after treatment were protective factor for the effective treatment of HFNC(P<0.05).ROC curves showed that the AUC(95%CI)of blood Lac before treatment and 12 hours after treatment,ROX index before treatment and 12 hours after treatment for predicting ineffective HFNC treatment were 0.680(0.568~0.779),0.730(0.621~0.822),0.776(0.670~0.860),and 0.823(0.723~0.899),respectively.Conclusion High blood Lac level and low ROX index before and 12 h after HFNC treatment in elderly patients with AECOPD are risk

关 键 词：慢性阻塞性肺疾病急性加重期 经鼻湿化高流量氧疗 血乳酸 ROX指数 

分 类 号：R563.9[医药卫生—呼吸系统]